Demystifying Hypnotherapy

Clinical hypnosis is an effective therapy for many psychosomatic conditions. Psychosomatic conditions refer to chronic physiological illness that is precipitated, worsened or maintained by psychological factors that may include anxiety, depression, distress, beliefs and expectations. Pain, fibromyalgia, headache, TMD, irritable bowel, hypertension and asthma are examples of physiological conditions frequently associated with psychosomatic illness. Clinical hypnosis is also effective for inducing analgesia in some (e.g. dental extraction, biopsy), and to treat affective disorders such as phobias, anger, anxiety and depression (irrespective of the presence of physiological pathology). Adaptive behavioral health modification such as smoking and substance use cessation and weight management are also effectively treated with hypnosis. While most health professionals have a descriptive understanding of the application of clinical hypnosis, the mechanics of operation are usually unfamiliar or misunderstood. The purpose of this information brief is to demystify hypnosis by providing a fundamental introduction of the technique and its use.

Clinical hypnosis must be discriminated from “stage hypnosis” which, arguably, is not a hypnotic phenomenon at all. Here, the performer entices the audience with the expectation that a selected, hypnotizable individual will be placed into a trance from which they will remember nothing at all. A susceptible target (which is easy to identify) is picked from the audience. Once on stage, before hundreds, and directed to go into trance and follow directions of the expert performer, the target responds accordingly. Whether the “trance” is real or not is not known because their performance on stage convinces the target of the legitimacy of their experience; contradiction would be incongruent with their behavior and embarrassing for the target. In contrast, during clinical hypnosis the patient remains in control of their faculties while they allow themselves to enter trance. The patient hears and understands what is being said but does so without the normal need to critically evaluate and judge what is being offered. Hypnotic trance is a state of detached awareness. The patient is actively engaged in a “fertile climate of responsive cooperation” during which therapeutic suggestions and instructions are offered. If the process is uncomfortable or threatening they will simply not cooperate. In any case “programming” or “getting stuck in trance” is not possible and has never been documented.

The hypnotic process typically consists of five stages: pre-induction, induction, deepening, therapy and termination. In the pre-induction stage the clinician establishes rapport, diagnoses the problem, demystifies hypnosis, and uses classic suggestibility tests to ascertain the patient’s hypnotic capacity. In the induction stage the clinician generally uses a preferred hypnosis script based mostly on suggestions of relaxation and fascination. Most individuals are somewhat familiar with this stage (e.g. “...as you allow your conscious mind to drift you may begin to enjoy the sensations of comfortably floating, just as you may have experienced some time in the past, lazily drifting down a meandering stream...”). The deepening stage is used to intensify the experience through techniques such as direct suggestion, counting and imagery (“As I count from 1 to 10 you will go deeper...”). In the therapy stage the clinician offers metaphorical or direct suggestions to elicit emotional or behavioral change. The therapy stage is where the work is done. If the clinician is able to ratify that the patient has entered a trance (e.g. “Your arm is so heavy that you cannot lift it. Try to lift your arm…”) then therapeutic suggestions are offered. These are usually presented within a metaphorical framework to help maintain the trance state, but are also often accompanied by direct suggestion (“Cigarettes will taste bad”). The therapeutic intervention is built around the patient’s inferred or directly stated goal for treatment (“I don’t enjoy things anymore”, “I’m afraid I will run out of medicine”, “I want to return to work”), utilizing their emotional and cognitive resources. For example, a former competitive runner now with arthritis pain may wish to increase her level of physical activity. For this person a therapeutic intervention would incorporate elements of stamina, pacing and strategy as personal resources to motivate adaptive behavioral changes. In the termination stage the patient is re-oriented and given ego-building suggestions (“You are a great person capable of doing many things on your own behalf”).

The required number of sessions to effect change isAkey variable depending on the goals of treatment and the hypnotizeability of the individual. In general, at least one session is used to establish the therapeutic relationship and treatment planning. For most psychosomatic conditions and behavioral modification 6-10 weekly or bi-weekly sessions is sufficient. “Booster” sessions 2-3 times per year maintain and strengthen therapeutic progress. Hypnosis is typically contraindicated for individuals with frank personality disorders or schizophrenia (i.e. psychoses). Visualization, relaxation and meditation differ from hypnosis in that while the former are good for stress reduction and may used to elicit trance they do not incorporate a therapeutic process.

Case Example:

A 77yo widowed woman was referred for therapy for depression following a relatively sudden and debilitating exacerbation of back pain, requiring a six day hospitalization, secondary to spinal stenosis. The patient reported that she couldn’t help crying when she met with her treating physicians. She believed that this was a sign of weakness and that it “frightened” her physicians who subsequently declined to either assume or continue her management. In our first session her history was obtained and a primary goal of meeting with physicians without crying was mutually established. Briefly, up until a few years ago she remained active with her very successful career as a studio dancer, teacher and respected dance apparels store owner for 28 years. She remained very socially active and was a very accomplished gardener. Presently her lifestyle had radically changed because of her pain. Now this previously independent, accomplished and capable lady was having difficulty adjusting to her newly realized physical (and emotional) limitations and confrontation with her progressing age. This adjustment reaction manifested as depression and resulted in crying spells when reflecting on her condition. Hypnosis was suggested for helping her to establish control of her crying and facilitate a productive relationship with appropriate healthcare providers. (Underlined words are embedded meanings of the pre-induction and were the therapeutic targets of the ensuing sessions). In our second session a light trance was induced to assess hypnotizeablity, demonstrate the phenomenon and establish trust. A deeper trance was established in the third session where metaphors akin to dancing were used for the induction (“…and your unconscious mind can dance with the flowing rhythm of my speech…”). The induction was confirmed and deepened using arm levitation wherein imaginary balloons attached to the patient’s arm resulted in it’s slight rising. Therapy was then initiated using a combination of metaphor and direct suggestion. In this case a metaphor of the (accomplished and powerful) pharos (i.e. the patient) building the great pyramids; lasting structures ingeniously engineered and built from scratch. This analogy was unconsciously associated with the patient’s own lifetime dance accomplishments and building and maintaining her respected dance apparels store. Direct suggestions were then used to link her demonstrated ability for success and meeting challenges (i.e. pyramid building and dance career) with having control over crying so that her meeting with physicians would produce useful results (…just as a choreographed dance is produced). The trance was then terminated using encouraging and supporting statements. The next week the patient reported that she was able to refrain from crying during her appointment with a new primary care physician. A subsequent hypnosis session was used to reinforce and extend this progress.